Endophthalmitis Workup

Updated: Jul 02, 2018
  • Author: Daniel J Egan, MD; Chief Editor: Liudvikas Jagminas, MD, FACEP  more...
  • Print
Workup

Laboratory Studies

The most important laboratory study for endophthalmitis is Gram stain and culture of the aqueous and vitreous obtained by the ophthalmologist.

Real-time polymerase chain reaction (RT-PCR) has improved diagnostic results over traditional culture. [22]

For endogenous endophthalmitis, other laboratory studies that may be performed include the following:

  • Complete blood count with differential - Evaluating for signs of infection, elevated white count, left shift

  • Erythrocyte sedimentation rate - Evaluating for rheumatic causes, chronic infections, or malignancy. The ESR is often normal in cases of endophthalmitis.

  • Blood urea nitrogen - Evaluating for renal failure or patients at increased risk

  • Creatinine - Evaluating for renal failure or patients at increased risk

Next:

Imaging Studies

Imaging studies include the following:

  • Chest radiograph - Evaluating for source of infection

  • Cardiac ultrasound - Evaluating for endocarditis as source of infection

  • CT scan/MRI of orbit - May help rule out other entities in the differential diagnosis

  • Ocular ultrasound – Helpful when positive findings are seen, such as low-amplitude mobile echoes, vitreous membranes, and thickening of the retina and choroid; however, sensitivity is not high enough to rule out the diagnosis with a negative ultrasound [3, 23]

Previous
Next:

Other Tests

Other tests include the following:

  • Blood cultures - Evaluating for source of infection

  • Urine culture - Evaluating for source of infection

  • Other cultures depending on clinical signs or symptoms

    • Cerebrospinal fluid - Evaluating for source of infection

    • Throat culture - Evaluating for source of infection

    • Stool - Evaluating for source of infection

    • Indwelling intravascular catheter tip - Evaluating for source of infection

    • A culture of the penetrating object, if available, can be a valuable resource.

    • Vitreous culture obtained by the ophthalmologist

Previous
Next:

Procedures

Ophthalmological evaluation includes the following:

  • Check visual acuity

  • Examine both eyes by slit lamp biomicroscopy

  • Intraocular pressure

  • Dilated funduscopy

  • Possible ultrasonography if fundus not well visualized (This will help determine if a retained intraocular foreign body is present, the density of the vitreitis, and if the retina is attached or not.)

  • Routine cultures should include aerobic, anaerobic, and fungal cultures.

Previous